MyMedR

Fulltext Understanding non ulcer dyspepsia

Loh KY, Kew ST

Med J Malaysia, 2008 Jun;63(2):174-6; quiz 177.

Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia.

Matched MeSH terms: Deglutition Disorders/physiopathology*; Deglutition Disorders/therapy

Fulltext A rare case of Dysphagia secondary to a large oesophageal lipoma

Koh KS, Chong VH, Yapp SK, Chong CF

Med J Malaysia, 2012 Oct;67(5):522-3.

PMID: 23770871

Dysphagia is considered a warning symptom that requires exclusion of significant pathology such as oesophageal cancer, especially in elderly patients. Benign neoplasms of the oesophagus are rare. We report the case of a 69-year-old lady who presented with a five years history of infrequent intermittent dysphagia that had rapidly progressed over one month. This was associated with globus sensation, weight loss, intermittent episodes of stridor and aspiration pneumonia. Investigations revealed a large oesophageal lipoma in the proximal oesophagus extending down to the lower oesophagus. This was successfully resected via a left cervical approach. She remained well two years after the surgery.

Matched MeSH terms: Deglutition Disorders*

Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review

Jaafar MH, Mahadeva S, Morgan K, Tan MP

J Nutr Health Aging, 2015 Feb;19(2):190-7.

PMID: 25651445 DOI: 10.1007/s12603-014-0527-z

OBJECTIVE: The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia.

METHODS: We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia.

RESULTS: 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.

CONCLUSIONS: Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.

Matched MeSH terms: Deglutition Disorders/complications; Deglutition Disorders/mortality; Deglutition Disorders/surgery; Deglutition Disorders/therapy*

Dysphagia in an elderly patient

Tan SH, Balachandran R, Prepageran N

Eur J Intern Med, 2019 02;60:e3-e4.

PMID: 29759815 DOI: 10.1016/j.ejim.2018.05.012

Matched MeSH terms: Deglutition Disorders/physiopathology*

Fulltext A Review of Food Texture Modification among Individuals with Cerebral Palsy: The Challenges among Cerebral Palsy Families

Kamal S, Kamaralzaman S, Sharma S, Jaafar NH, Chern PM, Hassan NI, et al.

Nutrients, 2022 Dec 09;14(24).

PMID: 36558401 DOI: 10.3390/nu14245241

Individuals with cerebral palsy (CP) frequently present with multiple feeding problems, which may require food texture modification to ensure safe feeding. This review aims to explore the challenges individuals with CP and their caregiver's face and recommend modified food textures to ensure safety and improve the quality of life and nutritional status. A systematic search was carried out through four databases (i.e., EBSCO (Medline), PubMed, Science Direct, and Web of Science) between January 2011 and May 2022. Out of 86 articles retrieved, seven were selected based on keywords and seven other studies through manual search-five cross-sectional studies, two qualitative studies, one correlational study, one mixed method study, one case-control study, two sections of books, and two educational materials. The findings suggest that preparation and intake of food with modified texture play a necessary role in the safety of swallowing in addition to physical, social, and environmental aspects. Safety was found to be the crucial part of the food texture modification provision besides considering the stress of the caregivers and the nutritional status of individuals with CP. Currently, there are no standard guidelines available pertaining to food texture modification. This led to uncertainties in the dietary provision among caregivers, which may lead to undernourishment. Hence, standard guidelines relating to food texture modification that focuses on food preparation and menus with calorie and nutrient information are timely to be developed.

Matched MeSH terms: Deglutition Disorders*

Oculopharyngeal muscular dystrophy: a case report and a review of literature

Lim CT, Chew CT, Chew SH

Ann Acad Med Singap, 1992 May;21(3):399-403.

PMID: 1416791

Most muscular dystrophies manifest as peripheral muscular weakness commencing at various age, however, oculopharyngeal muscular dystrophy (OPMD) is a rare hereditary disorder presenting in middle age with progressive dysphagia and bilateral blepharoptosis rather than peripheral muscular weakness. In the medical literature, OPMD has been well described in Canadians of French descent. So far, there is no publication of OPMD in the Malaysia-Singapore medical literature. This article documents this condition in a Chinese patient. A review of the literature is presented and the management of OPMD is discussed.

Matched MeSH terms: Deglutition Disorders/etiology*; Deglutition Disorders/physiopathology; Deglutition Disorders/surgery

Fulltext Dysphagia Lusoria From Saccular Aneurysm :A Cause Of: A Case Report

Irfan, M., Khairi, M.D., Baharudin, A.

International Medical Journal Malaysia, 2007;6(1):1-5.

MyJurnal

Dysphagia is a common symptom in patients presenting to the otorhinolaryngolgy clinic. However, vascular causes (dysphasia lusoria) are relatively rare. W report a case of dysphagia caused by a saccular aneurysm of the descending thoraric aorta. The outline of management is discussed.

Matched MeSH terms: Deglutition Disorders

Aortic arch anomalies: treatable causes of dysphagia and respiratory distress

Saw HS, Lim KH, Singh J, Singham KT

Med J Malaysia, 1979 Sep;34(1):48-51.

PMID: 542152

Matched MeSH terms: Deglutition Disorders/complications; Deglutition Disorders/etiology*; Deglutition Disorders/surgery

Fulltext Metallic foreign body penetrating the carotid sheath: a case report

Vamanshankar H, Nair AB, Rajan N

Malays J Med Sci, 2011 Jan;18(1):72-5.

PMID: 22135577

Foreign bodies are a common problem seen in otolaryngological practice. Of the reported foreign bodies, metallic foreign bodies are a rare entity. One of the least common complications of foreign body ingestion is penetration and migration. We describe a case of a migrating metallic foreign body in a 50-year-old woman with a history of accidental ingestion causing odynophagia. In the present case, the foreign body migrated extraluminally into the carotid sheath. Our review of literature revealed that few such cases have been reported.

Matched MeSH terms: Deglutition Disorders

Cervical osteoarthropathy: an unusual cause of dysphagia

Srinivas P, George J

Age Ageing, 1999 May;28(3):321-2.

PMID: 10475873

PRESENTATION: A 72-year-old man complained of progressive dysphagia for solids associated with a sensation of foreign body in his throat for 2 years. A barium swallow showed a bridging osteophyte between C4 and C5 vertebrae indenting the oesophagus posteriorly and displacing it anteriorly.

OUTCOME: He refused surgical intervention and was given dietary advice. After 6 months, his weight was steady and he was able to swallow semi-solid food without difficulty.

Matched MeSH terms: Deglutition Disorders/etiology*

Fulltext Oesophageal food bolus impaction

Elango S, Palaniappan SP, Lingam VS, George L

Singapore Med J, 1990 Dec;31(6):624-6.

PMID: 2281364

Impaction of food usually occurs in patients having obstructive lesions of the oesophagus. The food bolus impaction normally occurs in patients older than 60 years of age. Though food bolus impaction in the oesophagus is not uncommon, food bolus in the oesophagus causing complete obstruction resulting in total dysphagia is rare. This is a case report of a woman who had complete obstruction of the oesophagus following impaction by a piece of meat. The various treatment modalities available for such a condition are discussed.

Matched MeSH terms: Deglutition Disorders/etiology

Updates on diagnostic modalities for esophageal dysphagia

Lazarescu A, Chan WW, Gyawali CP, Lee YY, Xiao Y, Wu P

Ann N Y Acad Sci, 2020 12;1481(1):108-116.

PMID: 32875574 DOI: 10.1111/nyas.14453

Esophageal dysphagia is a common symptom in adults. Fluoroscopic contrast studies, endoscopy, and esophageal manometry have been used in the diagnosis of esophageal dysphagia for many years. The diagnostic yield has been improved with new test protocols that highlight abnormal bolus transit in the esophagus and outflow obstruction, as well as new high-definition and high-resolution technical advances in equipment. Functional luminal impedance planimetry and the addition of impedance to high-resolution esophageal manometry have also allowed the assessment of new parameters to better understand esophageal structure and function. In this concise review, we describe the role and utility of various diagnostic modalities in the assessment of patients with esophageal dysphagia.

Matched MeSH terms: Deglutition Disorders

Fulltext Dysphagia lusoria: a case report

Nik Qisti, F., Shahrun Niza, A.S., Razrim, R.

International Medical Journal Malaysia, 2016;15(2):73-76.

MyJurnal

Aberrant right subclavian artery is a rare cause of dysphagia. This is a congenital anomaly with the right
subclavian artery originating from the dorsal part of the aortic arch and coursing through the mediastinum
between the esophagus and the vertebral column. We report a case of a patient with chronic dysphagia
caused by this condition. We further discuss the case with regards to its clinical features and options of
management.

Matched MeSH terms: Deglutition Disorders

The sequelae of barium aspiration

Gendeh HS, Hashim ND, Mohammad Yunus MR, Gendeh BS, Kosai NR

ANZ J Surg, 2018 09;88(9):937-938.

PMID: 27122196 DOI: 10.1111/ans.13624

Matched MeSH terms: Deglutition Disorders/diagnosis; Deglutition Disorders/etiology

Fulltext Dysphagia due to anterior cervical osteophytes--a case report

Kareem BA, Sofiyan M, Subramanian S

Med J Malaysia, 2000 Sep;55(3):376-8.

PMID: 11200721

Dysphagia due to osteophytes in a young person is uncommon. We present a rare case of Forestier's disease causing dysphagia in a young lady without other bony involvement. The osteophytes were surgically removed and her symptoms resolved completely.

Matched MeSH terms: Deglutition Disorders/etiology*; Deglutition Disorders/radiography

Antrochoanal polyp--a rare paediatric emergency

Sharma HS, Daud AR

Int J Pediatr Otorhinolaryngol, 1997 Jul 18;41(1):65-70.

PMID: 9279638

An antrochoanal polyp, a common clinical entity, with a rare presentation is being reported. A 12 year old boy was brought to Accident and Emergency department with an unusual sudden presentation of polypoidal mass filling the oral cavity up to his incisors as a result of which he could not swallow and speak. Prior to this episode he had no complaints of the disease. An emergency removal was planned and only during the operation could it be diagnosed as a antrochoanal polyp because of its pedicle in the lateral wall of the nose, which was confirmed by histopathological examination.

Matched MeSH terms: Deglutition Disorders/pathology; Deglutition Disorders/surgery

Fulltext Dysphagia as a primary manifestation of thyrotoxicosis: a case report

Ramanathan M

Med J Malaysia, 1989 Mar;44(1):83-6.

PMID: 2626117

This report deals with a middle aged man in whom the presenting symptom of the disorder was dysphagia. The clinical approach to the final diagnosis of thyrotoxic myopathy causing dysphagia is outlined and the pathophysiology of dysphagia then discussed. The need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia is stressed.

Matched MeSH terms: Deglutition Disorders/etiology*; Deglutition Disorders/physiopathology

Fulltext Risk factors and outcome of dysphagia after an acute ischaemic stroke

Hamidon BB, Nabil I, Raymond AA

Med J Malaysia, 2006 Dec;61(5):553-7.

PMID: 17623955 MyJurnal

Dysphagia occurs frequently after a stroke. It is a major problem as patients are at risk of malnutrition and aspiration pneumonia. We aimed to identify the risk factors for and outcome of dysphagia over the first one month after an acute ischaemic stroke. Patients with acute first-ever ischaemic stroke admitted to the medical ward of Hospital Universiti Kebangsaan Malaysia (HUKM) between July 2004 and December 2004 were prospectively examined. Observation was done using pre-defined criteria. Demographic data, risk factors, and type of stroke were recorded on admission. The assessment of dysphagia was made using standardized clinical methods. All patients were followed up for three months. One hundred and thirty four patients were recruited in the study. Fifty-five patients (41%) had dysphagia at presentation. This number was reduced to 29 (21.6%) patients at one month. Logistic regression analysis revealed that age of more than 75 years [OR 5.20 (95% CI 1.89 - 14.30)], diabetes mellitus [OR 2.91 (95% CI 1.07 - 7.91)] and MCA infarct [OR 2.48 (95% CI 1.01-6.14)] independently predicts the occurrence of dysphagia after an acute stroke. Dysphagia at presentation was found to be an independent predictor of mortality at one-month [OR 5.28 (95% CI 1.51-18.45)] post ischaemic infarct. Dysphagia occurred commonly in ischaemic stroke. Advance age, diabetes mellitus and large infarcts were independently associated with the presence of dysphagia. Early stroke mortality can be independently predicted by the presence of dysphagia.

Matched MeSH terms: Deglutition Disorders/drug therapy*; Deglutition Disorders/etiology

Fulltext A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke

Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA

Med J Malaysia, 2006 Mar;61(1):59-66.

PMID: 16708735 MyJurnal

Dysphagia following stroke is common problem and is of particular concern because of its potental for malnutrition. Nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tube feeding are recognized methods for nutritional support for patients with persistent neurologic dysphagia. However, the former is associated with tube dislodgement and blockage that might compromise the patients' nutritional status. There have been few randomized prospective studies to date comparing the efficacy and safety of these 2 modes of dysphagia management in stroke patients. The objective of this study was to compare PEG with NG tube feeding after acute dysphagic stroke in terms of nutritional status and treatment failure. This was a randomized prospective clinical trial. A total of 23 consecutive patients who fulfilled the criteria were recruited from the medical wards in Hospital Universiti Kebangsaan Malaysia. The diagnosis of stroke (acute cerebral infarct) was based on clinical and brain computed tomographic (CT scan) findings; and the diagnosis of dysphagia was done clinically by using the 'swallowing test'. At recruitment, upper-arm skin fold thickness (triceps and biceps) and mid-arm circumference were measured; and blood was drawn for serum albumin level. They were then followed up at 4 weeks where the above tests were repeated. A total of 22 patients completed the study (12 patients in the NG group and 10 patients in the PEG group). Serum albumin levels (p = 0.045) were significantly higher in the PEG as compared to the NG group at 4 weeks post-intervention. There were statistically significant improvements in serum albumin level (p = 0.024) in the PEG group; and statistically significant reductions in serum albumin level (p = 0.047) in the NG group 4 weeks after the intervention. However, there were no significant differences in anthropometric parameters between the two groups and no significant changes in these parameters for each group 4 weeks after the intervention. Treatment failure occurred in 5 out of 10 patients (50.0%) in the NG group, but none in PEG group (p = 0.036). PEG tube feeding is more effective than NG tube feeding in improving the nutritional status (in terms of the serum albumin level) of patients with dysphagic stroke. NG tube feeding, in fact, reduced the nutritional status (in terms of the serum albumin level) of the patients.

Matched MeSH terms: Deglutition Disorders/etiology; Deglutition Disorders/therapy*

Fulltext Clinical performance of the LMA Protector™ airway in moderately obese patients

Shariffuddin II, Chaw SH, Ng LW, Lim CH, Zainal Abidin MF, Wan Zakaria WA, et al.

BMC Anesthesiol, 2020 07 31;20(1):184.

PMID: 32736516 DOI: 10.1186/s12871-020-01100-z

BACKGROUND: The 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society (NAP4) reported a higher incidence of supraglottic airway device (SAD) related pulmonary aspiration in obese patients especially with the first-generation SADs. The latest single-use SAD, the Protector™ provides a functional separation of the respiratory and digestive tracts and its laryngeal cuff with two ports allowing additional suction in tandem with the insertion of a gastric tube. The laryngeal cuff of LMA Protector™ allows a large catchment reservoir in the event of gastric content aspiration.

METHODS: We evaluated the performance characteristics of the LMA Protector™ in 30 unparalysed, moderately obese patients. First attempt insertion rate, time for insertion, oropharyngeal leak pressure (OLP), and incidence of complications were recorded.

RESULTS: We found high first and second attempt insertion rates of 28(93%) and 1(33%) respectively, with one failed attempt where no capnography trace could be detected, presumably from a downfolded device tip. The LMA Protector™ was inserted rapidly in 21.0(4.0) seconds and demonstrated high OLP of 31.8(5.4) cmH2O. Fibreoptic assessment showed a clear view of vocal cords in 93%. The incidence of blood staining on removal of device was 48%, postoperative sore throat 27%, dysphagia 10% and dysphonia 20% (all self-limiting, resolving a few hours postoperatively).

CONCLUSIONS: We conclude that the LMA Protector™ was associated with easy, expedient first attempt insertion success, demonstrating high oropharyngeal pressures and good anatomical position in the moderately obese population, with relatively low postoperative airway morbidity.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12617001152314 . Registered 7 August 2017.

Matched MeSH terms: Deglutition Disorders/etiology; Deglutition Disorders/epidemiology

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